Provider Demographics
NPI:1801957345
Name:GOMEZ, MARILYN E (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:E
Other - Last Name:TORRES-SIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3109 EAST CACTUS ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7155
Mailing Address - Country:US
Mailing Address - Phone:480-570-1897
Mailing Address - Fax:602-788-1570
Practice Address - Street 1:3109 EAST CACTUS ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7155
Practice Address - Country:US
Practice Address - Phone:480-570-1897
Practice Address - Fax:602-788-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-04713P246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other